The effects of ranolazine monotherapy on the incidence of atrial fibrillation in heart disease: a meta-analysis of randomized controlled trials

As the most common cardiac arrhythmia, atrial fibrillation (AF) increases health-care costs and morbidity. Ranolazine, a novel anti-angina drug, has unique antiarrhythmic properties, which have aroused interest in its use in AF prevention. To evaluate the effects of ranolazine monotherapy on the incidence of AF, randomized controlled trials (RCTs) that reported the effects of monotherapy with ranolazine on the incidence of AF and that were published up through May 2017 were searched in the Cochrane library, PubMed, and EMBASE databases. Data are expressed as the odds ratio (OR) with a 95% confidence interval (CI). Five RCTs involving 7003 patients (3580 in the ranolazine group, 3423 in the controls group) were included in the meta-analysis. Ranolazine monotherapy significantly reduced the incidence of AF (OR 0.66, 95% CI 0.50 to 0.87; P<0.01) compared with the controls, especially for postoperative (OR 0.33, 95% CI 0.13 to 0.79; P<0.05) or non-surgical patients (OR 0.72, 95% CI 0.53 to 0.98; P<0.05). Further analysis showed that a high dose of ranolazine could effectively prevent AF (OR 0.68, 95% CI 0.50 to 0.93; P<0.05), but a low dose group didn't have the effect of preventing AF (OR 0.46, 95% CI 0.14 to 1.56; P=0.08). Ranolazine monotherapy may prove beneficial in AF prevention in heart disease. However, not all doses of ranolazine can be effective in the prevention of AF. Therefore, further studies with large RCTs are warranted to confirm the effects of different doses of ranolazine monotherapy in AF therapy.